Identifying the early predictors of non-response to steroids in patients with flare of autoimmune hepatitis causing acute-on-chronic liver failure

Sharma S 1 , Agarwal S 1 , Saraya A 2 , Choudhury AK 3 , Saigal S 4 , Soin AS 4 Show all authors , Shukla A 5 , Sahu MK 6 , Lesmana LA 7 , Lesmana RC 7 , Shah SN 8 , Hu J 9 , Tan SS 10 , Jothimani D 11 , Rela M 11 , Ghazinyan HL 12 , Amrapurkar DN 13 , Eapen CE 14 , Goel A 14 , Payawal DA 15 , Hamid S 16 , Butt AS 16 , Zhongping D 17 , Singh V 18 , Duseja A 18 , Sood A 19 , Midha V 19 , Al Mahtab M 20 , Kim DJ 21 , Ning Q 22 , Kulkarni AV 23 , Rao PN 23 , Lee GH 24 , Treeprasertsuk S 25 , Shaojie X 26 , Karim MF 27 , Sollano JD 28 , Kalista KF 29 , Gani RA 29 , Prasad VGM 30 , Sarin SK 31 , APASL ACLF Research Consortium (AARC) for APASL ACLF working party

Affiliations 

  • 1 Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110026, India
  • 2 Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110026, India. ansaraya@yahoo.com
  • 3 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
  • 4 Department of Hepatology, Medanta, Medicity, Gurugram, Haryana, India
  • 5 Department of Gastroenterology, LTMMC, Mumbai, Maharashtra, India
  • 6 Department of Hepatology, IMS and SUM Hospital, Bhubneshwar, Odhisha, India
  • 7 Department of Medicine, Medistra Hospital, Jakarta, Indonesia
  • 8 Department of Hepatology, Global Hospital, Mumbai, India
  • 9 Department of Medicine, 302 Military Hospital, Bejing, China
  • 10 Department of Medicine, Hospital Selayang, Bata Cabs, Selangor, Malaysia
  • 11 Department of Liver Transplant and Surgery, Dr. Rela Institute and Medical Centre, Chennai, India
  • 12 Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia
  • 13 Bombay Hospital, Mumbai, Maharashtra, India
  • 14 Department of Hepatology, Christan Medical College, Vellore, India
  • 15 Department of Medicine, Cardinal Santos Medical Center, Metro Manila, Philippines
  • 16 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
  • 17 Translational Hepatology Institute Capital Medical University, Beijing You' an Hospital, Beijing, China
  • 18 Department of Hepatology, PGIMER, Chandigarh, India
  • 19 Department of Gastroenterology, Dayanand Medical College, Ludhiana, India
  • 20 Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 21 Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
  • 22 Department of Medicine, Tongji Hospital, Tongji Medical College, Wuhan, China
  • 23 Asian Institute of Gastroenterology, Hyderabad, India
  • 24 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
  • 25 Department of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 26 Medical School of Chinese PLA, Beijing, China
  • 27 Department of Hepatology, Sir Salimullah Medical College, Dhaka, Bangladesh
  • 28 Department of Medicine, University of Santo Tomas, Manila, Philippines
  • 29 Division of Hepatobiliary, Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia
  • 30 Department of Gastroenterology, VGM Hospital, Coimbatore, India
  • 31 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com
Hepatol Int, 2023 Aug;17(4):989-999.
PMID: 36790652 DOI: 10.1007/s12072-023-10482-4

Abstract

BACKGROUND AND AIMS: Early identification of non-response to steroids is critical in patients with autoimmune hepatitis (AIH) causing acute-on-chronic liver failure (ACLF). We assessed if this non-response can be accurately identified within first few days of treatment.

METHODS: Patients with AIH-ACLF without baseline infection/hepatic encephalopathy were identified from APASL ACLF research consortium (AARC) database. Diagnosis of AIH-ACLF was based mainly on histology. Those treated with steroids were assessed for non-response (defined as death or liver transplant at 90 days for present study). Laboratory parameters, AARC, and model for end-stage liver disease (MELD) scores were assessed at baseline and day 3 to identify early non-response. Utility of dynamic SURFASA score [- 6.80 + 1.92*(D0-INR) + 1.94*(∆%3-INR) + 1.64*(∆%3-bilirubin)] was also evaluated. The performance of early predictors was compared with changes in MELD score at 2 weeks.

RESULTS: Fifty-five out of one hundred and sixty-five patients (age-38.2 ± 15.0 years, 67.2% females) with AIH-ACLF [median MELD 24 (IQR: 22-27); median AARC score 7 (6-9)] given oral prednisolone 40 (20-40) mg per day were analyzed. The 90 day transplant-free survival in this cohort was 45.7% with worse outcomes in those with incident infections (56% vs 28.0%, p = 0.03). The AUROC of pre-therapy AARC score [0.842 (95% CI 0.754-0.93)], MELD [0.837 (95% CI 0.733-0.94)] score and SURFASA score [0.795 (95% CI 0.678-0.911)] were as accurate as ∆MELD at 2 weeks [0.770 (95% CI 0.687-0.845), p = 0.526] and better than ∆MELD at 3 days [0.541 (95% CI 0.395, 0.687), p  6, MELD score > 24 with SURFASA score ≥ - 1.2, could identify non-responders at day 3 (concomitant- 75% vs either - 42%, p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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